Short versus long course of antibiotics for catheter-associated urinary tract infections in patients with spinal cord injury: a randomized controlled noninferiority trial

Arch Phys Med Rehabil. 2014 Feb;95(2):290-6. doi: 10.1016/j.apmr.2013.09.003. Epub 2013 Sep 11.


Objective: To assess the applicability of a short-course regimen of antibiotics for managing catheter-associated urinary tract infection (CA-UTI) in patients with spinal cord injury (SCI).

Design: Randomized, controlled, noninferiority trial.

Setting: Medical center.

Participants: Patients with SCI who had CA-UTI (N=61).

Interventions: Patients were randomized to receive either a 5-day regimen of antibiotics after catheter exchange (experimental group) or a 10-day regimen of antibiotics with catheter retention (control group). Noninferiority was prespecified with a margin of 10%.

Main outcome measure: Clinical cure at the end of therapy.

Results: Of the 61 patients enrolled in this study, 6 patients were excluded because of bacteremia or absence of urinary symptoms. All patients (100%) achieved clinical cure at the end of therapy. The rates of microbiologic response were 82.1% in the experimental group and 88.9% in the control group (upper boundary 95% confidence interval (CI) for difference, 26%). The rates of resolution of pyuria were 89.3% in the experimental group and 88.9% in the control group (upper boundary 95% CI for difference, 16%). Patients in the experimental group had higher rates of CA-UTI recurrence than the control group. The rates of new CA-UTI, diarrhea, and Clostridium difficile colitis were similar in the 2 treatment arms.

Conclusions: The primary endpoint of the study was met, indicating that the 5-day regimen with catheter exchange was noninferior to the 10-day regimen with catheter retention on the basis of clinical cure. Criteria for noninferiority on the basis of microbiologic response and resolution of pyuria were not met.

Keywords: AE; CA-UTI; CI; Catheters; EOT; MEDVAMC; Michael E. DeBakey Veterans Affairs Medical Center; Rehabilitation; SCI; Spinal cord injuries; UTI; Urinary tract infections; adverse event; catheter-associated urinary tract infection; confidence interval; end of therapy; spinal cord injury; urinary tract infection.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Device Removal
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Spinal Cord Injuries / complications*
  • Treatment Outcome
  • Urinary Catheterization / adverse effects*
  • Urinary Tract Infections / drug therapy*
  • Urinary Tract Infections / etiology*
  • Urinary Tract Infections / microbiology


  • Anti-Bacterial Agents